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Medial Medullary Syndrome Overview

Medial medullary syndrome is caused by an occlusion of the anterior spinal artery, resulting in an infarction of the medial part of the medulla oblongata. It is characterized by ipsilateral tongue deviation, contralateral limb weakness, and loss of sensation on the contralateral side. The syndrome causes both contralateral and ipsilateral symptoms due to damage to structures like the hypoglossal nerve fibers, medullary pyramid, and medial lemniscus. Sensation of pain and temperature are preserved as the spinothalamic tract is located more laterally.

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188 views8 pages

Medial Medullary Syndrome Overview

Medial medullary syndrome is caused by an occlusion of the anterior spinal artery, resulting in an infarction of the medial part of the medulla oblongata. It is characterized by ipsilateral tongue deviation, contralateral limb weakness, and loss of sensation on the contralateral side. The syndrome causes both contralateral and ipsilateral symptoms due to damage to structures like the hypoglossal nerve fibers, medullary pyramid, and medial lemniscus. Sensation of pain and temperature are preserved as the spinothalamic tract is located more laterally.

Uploaded by

Arun Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Medial medullary

syndrome

Medial medullary syndrome, also known


as inferior alternating syndrome,
hypoglossal alternating hemiplegia, lower
alternating hemiplegia,[1] or Dejerine
syndrome,[2] is a type of alternating
hemiplegia characterized by a set of
clinical features resulting from occlusion
of the anterior spinal artery. This results in
the infarction of medial part of the medulla
oblongata.

Medial medullary syndrome

Medulla oblongata, shown by a transverse


section passing through the middle of the olive.
(Medial medullary syndrome can affect structures
in lower left: especially #5, #6, #8.)

Specialty Neurology 
Presentation
The condition usually consists of:

Number
Description Source of damage on
diagram

a deviation of the tongue to the side of the infarct


on attempted protrusion, caused by ipsilateral hypoglossal nerve fibers #8
muscle weakness.

medullary pyramid and hence to


limb weakness (or hemiplegia, depending on
the corticospinal fibers of the #5
severity), on the contralateral side of the infarct
pyramidal tract

a loss of discriminative touch, conscious


proprioception, and vibration sense on the medial leminiscus #6
contralateral side of the infarct

Human brainstem blood supply description. ASA is


Human brainstem blood supply description. ASA is
#13.

Sensation to the face is preserved, due to


the sparing of the trigeminal nucleus.

The syndrome is said to be "alternating"


because the lesion causes symptoms both
contralaterally and ipsilaterally. Sensation
of pain and temperature is preserved,
because the spinothalamic tract is located
more laterally in the brainstem and is also
not supplied by the anterior spinal artery
(instead supplied by the posterior inferior
cerebellar arteries and the vertebral
arteries).
Pathophysiology
The infarction (which arises in the
paramedian branches of the anterior
spinal artery and/or the vertebral arteries)
leads to death of the ipsilateral medullary
pyramid, the medial leminiscus, and the
hypoglossal nerve fibers that pass through
the medulla. The spinothalamic tract is
spared because it is located more laterally
in the brainstem and is not supplied by the
anterior spinal artery, but rather by the
vertebral and posterior inferior cerebellar
arteries. The trigeminal nucleus is also
spared, since most of it is higher up in the
pons, and the spinal part of it found in the
medulla is lateral to the infarct.

Diagnosis
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Management
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See also
Alternating hemiplegia of childhood
Lateral medullary syndrome
Lateral pontine syndrome
Medial pontine syndrome

References
1. "Atlas of Microscopic Anatomy: Section
17 - Central Nervous System. Plate 17.330
Medulla Oblongata" . Retrieved 2007-06-07.
2. Yokota J, Amakusa Y, Tomita Y,
Takahashi S (February 2003). "[The medial
medullary infarction (Dejerine syndrome)
following chiropractic neck manipulation]".
No To Shinkei (in Japanese). 55 (2): 121–5.
PMID 12684991 .

External links
Classification ICD-10: G46.3 D

External resources eMedicine: emerg/834


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